Video: Waiting for pap tests

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>>>well, just days after controversial guidelines came out recommending changes in screening mammography, the
american college
of gynecologist are releasing new guidelines for
cervical cancer
screening. screening
women
three years after they first had sex or by the age of 21, whichever came first. but
women
have their first screening at age 21 regardless of their sexual activity and it also recommends that
women
under 30 have pap tests every two years instead of annually. those over the age of 30 with three negative tests in a row can then have one every three years. the lingering question now, will these new guidelines be as politically charged as the ones were for mammography earlier in the week. with me now lisa gurara and also an obstetrician gynecologist and you did your fellowship at pittsburgh where i did my ent.

>>i did. thank you for having me, dr. nancy.

>>you were a colleague. let's talk about the recommendation. i am going to assume that because you are just out of your fellowship and young that you're not going bulk at the science and not so entrenched in the anecdotes and be able to take the blinders off. explain what these guidelines are and why they are important.

>>well, the reason that they're so important is because we want to reduce the risk of unnecessary procedures to
young women
. what we found is that by getting pap smears too frequently
women
are needing procedures called coalposcopies and needing leap procedures which remove abnormal cells from the cervix. if we left those
women
alone they would likely clear that infection on their own without any procedure at all.

>>there's an interesting sort of shift here because i have been in politics and science all week along. if you look at the american institution of obstetrics and gynecolo gynecology, we'll cut back on procedures, which seems prudent and less money reimbursement, if, in fact, they do the right thing. other people will look at this and say it's one more sign that we're rationing and taking things away from
women
.

>>well, i have to say that i don't agree with that. this guideline is to help
women
. what we found is that if
women
get these procedures, it actually does increase the risk of
preterm delivery
in their future pregnancies. so, sure, we're cutting back on costs, but this is not rationing.

>>so, let's talk for a second about hpv, the big
risk factor
for
cancer of the cervix
and the role of vaccination, which isn't one of the recommendations but certainly seems like an important message to pass on to people.

>>well, the recommendation is that all females age 9 through 26 years old be vaccinated with the
hpv vaccine
. it protects against four strains of the virus that either cause
cervical cancer
or gentle warts. so, yeah, it's a recommendation. i think it's another very good way to reduce
cervical cancer
rates.

>>and, lisa, yes or no question. based on the mammography changes from monday, will you advise your patients differently?

>>what i do, i meet with my patient and i speak with every patient on a case-by-case basis. so, no, i'm not going to change anything i do.

>>you're going to keep doing it the way you've been doing it.

>>i will take it on a case-by-case basis.

>>intelligent answer. guidelines are not mandates. thanks for being with

WASHINGTON — Most women in their 20s can have a Pap smear every two years instead of annually, say new guidelines that conclude that's enough to catch slow-growing cervical cancer.

The change by the American College of Obstetricians and Gynecologists comes amid a completely separate debate over when regular mammograms to detect breast cancer should begin. The timing of the Pap guidelines is coincidence, said ACOG, which began reviewing its recommendations in late 2007 and published the update Friday in the journal Obstetrics & Gynecology. There have been widespread concerns that the government is trying to
cut health costs
by limiting cancer screening for women.

However, the recommendations have been in development for the last several years and the announcement of the new guidelines was coincidental, Dr. Cheryl B. Iglesia, the chairwoman of a panel in the obstetricians’ group that developed the Pap smear guidelines, told The New York Times. The timing of the announcement was “an unfortunate perfect storm,” she told the newspaper, adding, “there’s no political agenda with regard to these recommendations.”

The recommendations are based on scientific evidence that suggests more frequent testing leads to overtreatment, which can harm a young woman's chances of carrying a child full term, according to Dr. Thomas Herzog of Columbia University in New York, who is chairman of an ACOG subcommittee on gynecologic cancers.

"Overtreatment of minor abnormal pap tests in young women and adolescents can lead to consequences such as preterm labor in some cases. It increases the risk," said Herzog.

Dr. Jennifer Milosavijevic, a specialist in obstetrics and gynecology at Henry Ford Health System in Detroit, supports the guideline changes. "Preterm delivery has become a huge problem in the United States that has potential serious consequences for the unborn fetus," she said.

The guidelines are unlikely to be met with the kind of rebellion that accompanied the mammogram guidelines this week, which were largely based on computer projections, Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said in a telephone interview.

"There is a lot more agreement about the science of cervical cancer screening," Lichtenfeld said.

Herzog said the new recommendations are based on studies that suggest starting screening earlier than age 21 causes more harm than benefit.

"We were overdiagnosing and overtreating adolescents and very young women," Herzog said in a telephone interview.

The guidelines also say:

Routine Paps should start at age 21. Previously, ACOG had urged a first Pap either within three years of first sexual intercourse or at age 21.

Women 30 and older should wait three years between Paps once they've had three consecutive clear tests. Other national guidelines have long recommended the three-year interval; ACOG had previously backed a two- to three-year wait.

Women with HIV, other immune-weakening conditions or previous cervical abnormalities may need more frequent screening.

Paps can spot pre-cancerous changes in the cervix in time to prevent invasive cancer, and widespread use has halved cervical cancer rates in the U.S. in recent decades. About 11,270 new cases will be diagnosed this year, and about 4,070 women will die from it, according to American Cancer Society estimates. Half of women diagnosed with cervical cancer have never had a Pap, and another 10 percent haven't had one in five years.

Cervical cancer is caused by certain strains of the extremely common sexually transmitted virus called HPV, for human papillomavirus. There is a new HPV vaccine that should cut cervical cancer in the future; ACOG's guidelines say for now vaccinated women should follow the same Pap guidelines as the unvaccinated.

But the updated guidelines reflect better understanding of HPV. Infection is high among sexually active teens and young adults. Women's bodies very often fight off an HPV infection on their own without lasting harm, although it can take a year or two. The younger the woman, the more likely that HPV is going to be transient.

Moreover, ACOG cited studies showing no increased risk of cancer developing in women in their 20s if they extended Pap screening from every year to every two years.

As for adolescents, ACOG said cervical cancer in teens is rare — one or two cases per million 15- to 19-year-olds — while HPV-caused cervical abnormalities usually go away on their own, and unnecessary treatment increases the girls' risk of premature labor years later.